Emerging Role of Targeted Arterial Embolization in Achilles Tendinopathy

Achilles tendinopathy (AT) affects ∼6% of the general population, with 20% of patients remaining symptomatic at 10 years despite conservative therapy. Transarterial embolization (TAE) is an endovascular technique targeting aberrant neovascularization. This review evaluates TAE's mechanistic rationale, technique, clinical effectiveness, and emerging role in treating AT. Five case series encompassing 139 patients (202 procedures) demonstrated consistent effectiveness, primarily in athletes. Pain scores (visual analog/numerical rating scales) decreased 60%-83%, from 6.7-8.2 at baseline to 1.4-2.7 at 6-24 months. Victorian Institute of Sports Assessment-Achilles scores improved from 28.6-48.4 to 70.9-76.9 at 6 months, transitioning patients from severe to mild impairment. Clinical success (≥50% pain reduction) was achieved in 82%-100% of patients. No major adverse events or tendon ruptures were reported. TAE is an emerging therapy offering meaningful pain reduction and a favorable safety profile in refractory AT with angiographic hypervascularity, although specific patient indications remain understudied.